Wiki code - Mr Doe had OV & I&D

[michaelrcpc]

Mr Doe had OV & I&D for cellulitis on 1st day; was given rocephin injection. All services were paid.
Mr Doe came in on 3rd day & was admitted to hospital for IV antibiotics as infection was deep & had worsened.
Mr Doe was inpatient 3 days and all 3 are denied as being inclusive in I&D.
Please help!!

 

[Christine Bekker]

Did you try modifier -24 Unrelated evaluation and management service by the same physician during a postoperative period?

 

[ibrcc]

Only problem is, you can't use modifier -24 to signify the service is 'unrelated' when it's really related. It will depend on the diagnosis. Is the diagnosis for the hospital service the same or 'related'? It sure sounds like it is.

 

[Lisa Bledsoe]

Mr Doe had OV & I&D for cellulitis on 1st day; was given rocephin injection. All services were paid.
Mr Doe came in on 3rd day & was admitted to hospital for IV antibiotics as infection was deep & had worsened.
Mr Doe was inpatient 3 days and all 3 are denied as being inclusive in I&D.
Please help!!

If this is a Medicare patient then it is inclusive - period. Medicare will only pay if the patient is taken back to the OR or procedure room. Are you using a post-op infection ICD-9 code or just the cellulitis code?